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1.
Neurosurg Rev ; 43(4): 1117-1125, 2020 Aug.
Article in English | MEDLINE | ID: mdl-31236728

ABSTRACT

Anterior lumbar interbody fusion (ALIF) combined with posterior column osteotomy (PCO) may be effective to achieve ideal lumbar curve correction in lumbar flat-back deformity (LFD). We aimed to investigate the radiographic and clinical outcomes of patients with primary degenerative LFD treated with multi-level ALIFs combined with PCOs. Seventy patients with primary degenerative LFD who underwent corrective surgery were divided into three groups according to the 1-month postoperative pelvic incidence/lumbar lordosis (PI-LL) angles (≤ - 10Ā°, from - 9Ā° to 9Ā°, and ≥ 10Ā°). The spinopelvic parameters, including thoracic kyphosis, LL, pelvic tilt, T1 pelvic angle, and sagittal vertical axis, were analyzed at the preoperative, postoperative follow-up periods. The clinical outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS), and Scoliosis Research Society (SRS)-22r, were also evaluated. Further, the paraspinal muscles were qualitatively and quantitatively examined, preoperatively. All spinopelvic parameters were corrected as close to the normal values at the 1-month postoperative period. The spinopelvic parameters in the PI-LL ≤ - 10Ā° group were better corrected and maintained than those in the other groups. The ODI, VAS, and SRS-22r scores improved at the final follow-up in all groups. The PI-LL ≤ - 10Ā° group showed better clinical outcomes than the other groups. In the paraspinal muscle examination, the mean lumbar muscularity value and fatty degeneration ratio were 236.7% and 20.7%, respectively. Multi-level ALIFs with PCOs in patients with LFD are effective in restoring sagittal balance and improving clinical symptoms. In addition, the postoperative LL angles should be larger than PI + 10Ā° to achieve good overall outcomes in patients with severe degenerative back muscle.


Subject(s)
Lumbar Vertebrae/abnormalities , Lumbar Vertebrae/surgery , Osteotomy/methods , Spinal Fusion/methods , Aged , Back Muscles/pathology , Back Muscles/surgery , Disability Evaluation , Female , Follow-Up Studies , Humans , Intervertebral Disc Degeneration/surgery , Kyphosis/surgery , Lordosis/surgery , Lumbar Vertebrae/diagnostic imaging , Lumbosacral Region , Male , Middle Aged , Neurosurgical Procedures , Pain Measurement , Pelvis/surgery , Scoliosis/surgery , Treatment Outcome
2.
Medicina (Kaunas) ; 56(9)2020 Aug 27.
Article in English | MEDLINE | ID: mdl-32867138

ABSTRACT

Granulomatosis with polyangiitis (GPA) is an autoimmune disease which is a type of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis that frequently affects the lungs and kidneys. However, GPA limited to a single organ has also been reported. A 71-year-old man was admitted for back pain and fever. We detected elevated levels of inflammatory markers and myeloperoxidase-ANCA. Magnetic resonance imaging indicated diffuse inflammation of the back and psoas muscles. Histology showed degenerated muscle fibers and granulomatosis vasculitis with mixed lymphoplasma cell infiltration. High-dose methylprednisolone therapy improved his symptoms. A final diagnosis of GPA limited to the muscles was made.


Subject(s)
Back Muscles/pathology , Granulomatosis with Polyangiitis/pathology , Aged , Anti-Inflammatory Agents/therapeutic use , Antibodies, Antineutrophil Cytoplasmic/blood , Back Muscles/diagnostic imaging , Biomarkers/blood , Granulomatosis with Polyangiitis/blood , Granulomatosis with Polyangiitis/diagnostic imaging , Granulomatosis with Polyangiitis/drug therapy , Humans , Male , Methylprednisolone/therapeutic use , Peroxidase/blood , Psoas Muscles/diagnostic imaging , Psoas Muscles/pathology
3.
Support Care Cancer ; 27(4): 1207-1213, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30220027

ABSTRACT

PURPOSE: Morphometric analyses have shown that trunk muscle mass and density are associated with mortality in cancer patients. Because of the low incidence of spinal metastasis from gastrointestinal cancer and the limited life expectancy of these patients, few studies have been reported in this population. We evaluated the prognostic value of trunk muscle area and density in predicting overall survival. METHODS: The data from 78 patients with spinal metastases from gastrointestinal cancer, collected from February 2009 to July 2016, were evaluated. Psoas muscle and paravertebral muscle area and density were measured at the L3 level on CT scans taken at the time nearest to the diagnosis of spinal metastasis. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS: The mean patient age was 68.3Ā years (range, 42-88Ā years). The overall median survival time was 4.8Ā months: 2.2Ā months in the extremely rapid growth group (stomach, biliary tract, and pancreas) and 7.6Ā months in the rapid growth group (esophagus, liver, and colorectum). Multivariate analyses showed that lower paravertebral muscle density (HR 2.23 [95% CI 1.24-3.99], p = 0.007), extremely rapid growth group, presence of abnormal laboratory data, poor performance status, and chemotherapy after spinal metastasis were independent prognostic factors. CONCLUSIONS: Median overall survival was poor among patients with spinal metastases from gastrointestinal carcinoma, especially among those with gastric, biliary tract, or pancreatic cancer. Lower paravertebral muscle density was an independent poor prognostic factor in patients with spinal metastases from gastrointestinal cancer.


Subject(s)
Back Muscles/pathology , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/pathology , Muscle, Skeletal/pathology , Spinal Neoplasms/diagnosis , Spinal Neoplasms/secondary , Adult , Aged , Aged, 80 and over , Back Muscles/diagnostic imaging , Cell Count , Female , Gastrointestinal Neoplasms/epidemiology , Humans , Male , Middle Aged , Muscle, Skeletal/diagnostic imaging , Predictive Value of Tests , Prognosis , Retrospective Studies , Spinal Neoplasms/epidemiology , Spine , Tomography, X-Ray Computed
4.
Surg Today ; 49(12): 1022-1028, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31309328

ABSTRACT

PURPOSE: To investigate the change in skeletal muscle mass and evaluate the prognostic impact of sarcopenia on esophageal cancer (EC) patients METHODS: The subjects of this retrospective study were 90 EC patients who were treated with neoadjuvant chemotherapy (NAC) and subsequent esophagectomy. The skeletal muscle index (SMI) was defined according to computed tomography (CT) imaging of the total cross-sectional muscle tissue, measured at the third lumbar level using a volume analyzer before NAC and surgery. The SMI was calculated by normalization according to height, and skeletal muscle loss (SML) was defined as (pre-NAC SMI value - preoperative SMI value) Ɨ 100/pre-NAC SMI. RESULTS: Sarcopenia was evident in 72 (80.0%) patients before NAC and 77 (85.6%) patients before NAC and surgery. The SMI value was decreased in 28 (68.9%) patients and the median SML was 3.3%. The 3-year overall survival rate was 68.9% in the low SML group and 0% in the high SML group (P < 0.001). Sarcopenia before NAC or surgery was not significantly associated with overall survival. Multivariable analysis identified high SML as an independent prognostic factor. CONCLUSIONS: These results suggest that skeletal muscle loss is associated with a worse long-term outcome for EC patients treated with NAC.


Subject(s)
Back Muscles/diagnostic imaging , Back Muscles/pathology , Chemotherapy, Adjuvant , Esophageal Neoplasms/therapy , Neoadjuvant Therapy , Sarcopenia/complications , Adult , Aged , Esophageal Neoplasms/complications , Esophagectomy , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Sarcopenia/diagnostic imaging , Sarcopenia/pathology , Time Factors
5.
HPB (Oxford) ; 20(8): 715-720, 2018 08.
Article in English | MEDLINE | ID: mdl-29519644

ABSTRACT

BACKGROUND: Myosteatosis, characterized by inter- and intramyocellular fat deposition, is strongly related to poor overall survival after surgery for periampullary cancer. It is commonly assessed by calculating the muscle radiation attenuation on computed tomography (CT) scans. However, since magnetic resonance imaging (MRI) is replacing CT in routine diagnostic work-up, developing methods based on MRI is important. We developed a new method using MRI-muscle signal intensity to assess myosteatosis and compared it with CT-muscle radiation attenuation. METHODS: Patients were selected from a prospective cohort of 236 surgical patients with periampullary cancer. The MRI-muscle signal intensity and CT-muscle radiation attenuation were assessed at the level of the third lumbar vertebra and related to survival. RESULTS: Forty-seven patients were included in the study. Inter-observer variability for MRI assessment was low (R2Ā =Ā 0.94). MRI-muscle signal intensity was associated with short survival: median survival 9.8 (95%-CI: 1.5-18.1) vs. 18.2 (95%-CI: 10.7-25.8) months for high vs. low intensity, respectively (pĀ =Ā 0.038). Similar results were found for CT-muscle radiation attenuation (low vs. high radiation attenuation: 10.8 (95%-CI: 8.5-13.1) vs. 15.9 (95%-CI: 10.2-21.7) months, respectively; pĀ =Ā 0.046). MRI-signal intensity correlated negatively with CT-radiation attenuation (r=-0.614, pĀ <Ā 0.001). CONCLUSIONS: Myosteatosis may be adequately assessed using either MRI-muscle signal intensity or CT-muscle radiation attenuation.


Subject(s)
Adipose Tissue/diagnostic imaging , Ampulla of Vater/surgery , Back Muscles/diagnostic imaging , Magnetic Resonance Imaging , Muscular Diseases/diagnostic imaging , Pancreatectomy , Pancreatic Neoplasms/surgery , Tomography, X-Ray Computed , Adipose Tissue/pathology , Aged , Ampulla of Vater/diagnostic imaging , Ampulla of Vater/pathology , Back Muscles/pathology , Female , Health Status , Humans , Male , Middle Aged , Muscular Diseases/mortality , Muscular Diseases/pathology , Observer Variation , Pancreatectomy/adverse effects , Pancreatectomy/mortality , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Predictive Value of Tests , Prospective Studies , Radiographic Image Interpretation, Computer-Assisted , Reproducibility of Results , Risk Factors , Time Factors , Treatment Outcome
6.
Kyobu Geka ; 71(9): 716-719, 2018 09.
Article in Japanese | MEDLINE | ID: mdl-30185751

ABSTRACT

Elastofibroma is a relatively rare tumor that occurs commonly at the apex of scapula in elderly people. We report a case of elastofibroma of a female in her seventies. She visited our hospital with complaints of painful mass in her back, which was increasing in size. On the magnetic resonance imaging (MRI),the T1 and the T2-weighted images showed the same signal intensity as the muscle between the right scapula and the intercostal muscles. The internal fat component was cord-like, with high signal intensity. Based on the site of the tumor and characteristic findings on imaging, it was diagnosed as elastofibroma and resection was performed. Pathological findings revealed bundle-like proliferation of fibrous and spherical hyaline substances, together with collagen fibers. The hyaline substance stained in black on Elastica van Gieson staining and was confirmed to be elastic fiber. Thus, it was diagnosed as elastofibroma. The patient is on regular follow-up, with no recurrence after surgery.


Subject(s)
Back Muscles , Fibroma , Muscle Neoplasms , Aged , Back Muscles/diagnostic imaging , Back Muscles/pathology , Elastic Tissue/diagnostic imaging , Elastic Tissue/pathology , Female , Fibroma/diagnostic imaging , Fibroma/pathology , Humans , Magnetic Resonance Imaging , Muscle Neoplasms/diagnostic imaging , Muscle Neoplasms/pathology , Scapula
7.
Aging Clin Exp Res ; 28(3): 429-34, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26319656

ABSTRACT

BACKGROUND: Age-related change of spinal alignment in the standing position is known to be associated with decreases in walking speed, and alteration in muscle quantity (i.e., muscle mass) and muscle quality (i.e., increases in the amount of intramuscular non-contractile tissue) of lumbar back muscles. Additionally, the lumbar lordosis angle in the standing position is associated with walking speed, independent of lower-extremity muscle strength, in elderly individuals. However, it is unclear whether spinal alignment in the standing position is associated with walking speed in the elderly, independent of trunk muscle quantity and quality. The present study investigated the association of usual and maximum walking speed with age, sagittal spinal alignment in the standing position, muscle quantity measured as thickness, and quality measured as echo intensity of lumbar muscles in 35 middle-aged and elderly women. METHODS: Sagittal spinal alignment in the standing position (thoracic kyphosis, lumbar lordosis, and sacral anterior inclination angle) using a spinal mouse, and muscle thickness and echo intensity of the lumbar muscles (erector spinae, psoas major, and lumbar multifidus) using an ultrasound imaging device were also measured. RESULTS: Stepwise regression analysis showed that only age was a significant determinant of usual walking speed. The thickness of the lumbar erector spinae muscle was a significant, independent determinant of maximal walking speed. CONCLUSIONS: The results of this study suggest that a decrease in maximal walking speed is associated with the decrease in lumbar erector spinae muscles thickness rather than spinal alignment in the standing position in middle-aged and elderly women.


Subject(s)
Back Muscles , Posture/physiology , Walking Speed/physiology , Adult , Age Factors , Aged , Back Muscles/diagnostic imaging , Back Muscles/pathology , Back Muscles/physiopathology , Female , Humans , Japan , Middle Aged , Organ Size , Statistics as Topic , Ultrasonography/methods
8.
Ultraschall Med ; 36(3): 264-9, 2015 Jun.
Article in English | MEDLINE | ID: mdl-24647766

ABSTRACT

PURPOSE: The long thoracic nerve (LTN) innervates the serratus anterior muscle (SA) which plays an important role in shoulder function. Evaluation of the LTN has so far been restricted to clinical assessment and partly electromyography and neurography. Progress of high-resolution ultrasound (HRUS) increasingly enables visualization of small peripheral nerves and their pathologies. We therefore aimed at (a) clarifying the possibility of visualization of the LTN from its origin to the most distal point in the supraclavicular region visible and (b) developing an ultrasound protocol for routine use. We further present two cases of patients with LTN pathology. METHODS: The study consisted of two parts: Part 1 included 4 non-enbalmed human bodies in whom the LTN (nĆ¢Ā€ĀŠ=Ć¢Ā€ĀŠ8) was located and then marked by ink injection. Correct identification was confirmed by anatomical dissection. Part 2 included 20 healthy volunteers whose LTN (nĆ¢Ā€ĀŠ=Ć¢Ā€ĀŠ40) was assessed independently by two radiologists. Identification of the LTN was defined as consensus in recorded images. RESULTS: LTN was clearly visible in all anatomical specimens and volunteers using HRUS and could be followed until the second slip of the serratus anterior muscle from the supraclavicular region. In anatomical specimens, dissection confirmed HRUS findings. For all volunteers, consensus was obtained. The mean nerve diameter was 1.6Ć¢Ā€ĀŠmm Ā±Ć¢Ā€ĀŠ0.3 (range 1.1Ć¢Ā€ĀŠ-Ć¢Ā€ĀŠ2.1Ć¢Ā€ĀŠmm) after the formation of the main trunk. DISCUSSION: We hereby confirm a reliable possibility of visualization of the LTN in anatomical specimens as well as in volunteers. We encourage HRUS of the LTN to be part of the diagnostic work-up in patients presenting with scapular winging, shoulder weakness or pain of unknown origin.


Subject(s)
Back Muscles/diagnostic imaging , Back Muscles/innervation , Image Enhancement/methods , Thoracic Nerves/diagnostic imaging , Ultrasonography/instrumentation , Ultrasonography/methods , Adult , Back Muscles/injuries , Back Muscles/pathology , Electromyography , Female , Humans , Male , Middle Aged , Muscular Atrophy/diagnostic imaging , Muscular Atrophy/pathology , Neuroma/diagnostic imaging , Neuroma/pathology , Reference Values , Scapula/innervation , Sensitivity and Specificity , Thoracic Nerves/injuries , Thoracic Nerves/pathology , Traction/adverse effects , Young Adult
9.
J Spinal Disord Tech ; 26(4): E124-9, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23096127

ABSTRACT

STUDY DESIGN: A retrospective study. OBJECTIVE: Thoracolumbar fascia (TLF) is an important anatomic structure that plays a role in integrating back muscles and maintaining the stability of lower back. Functional failure of TLF can be one of the factors in the vicious cycle of progressive spinal instability. The purpose of this study is to assess the TLF and correlate it with spinal stability in the instrumented lumbar surgery patients. MATERIALS AND METHODS: From January 2008 to March 2009, 68 consecutive postoperative lumbar or thoracolumbar spine magnetic resonance images were retrospectively reviewed to evaluate the morphologic changes of TLF. It was considered as "sagging posterior layer TLF" when it showed abrupt bulging appearance on parasagittal planes. To determine the spinal stability, flexion and extension lumbar lateral films were also reviewed. The correlation between sagging TLF and adjacent segment disease (ASD) were analyzed. RESULT: Fifty patients (19 males and 31 females, mean age 52.4 y) showed sagging posterior layer TLF, and 32 of them developed ≥1 junctional problems, such as retrolistheses (n=25), compression fractures (n=5), spondylolistheses (n=4), progressive scoliosis (n=4), and segmental instability with bone marrow change (n=2). There was statistically significant correlation between the instrumented surgery and sagging TLF (P-value <0.001). And there was also significant correlation between the sagging TLF and ASD (P-value <0.001). CONCLUSIONS: Morphologic changes of the TLF in postoperative magnetic resonance imaging can be the earliest and predictable findings in the progressive development of the ASD.


Subject(s)
Back Muscles/pathology , Muscular Diseases/epidemiology , Muscular Diseases/pathology , Spinal Diseases/epidemiology , Spinal Diseases/pathology , Aged , Back Muscles/surgery , Causality , Comorbidity , Female , Humans , Lumbar Vertebrae/pathology , Male , Prevalence , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Spinal Diseases/surgery , Spinal Fusion , Thoracic Vertebrae/pathology
10.
World Neurosurg ; 148: e547-e555, 2021 04.
Article in English | MEDLINE | ID: mdl-33497826

ABSTRACT

BACKGROUND: Many factors affect spinal alignment in adult spinal deformity with sagittal imbalance. However, although the importance of the paravertebral muscle and ligamentum complex in proper spinal alignment is well recognized, little information is available regarding the role of the paravertebral muscles in maintaining sagittal spinal alignment. METHODS: A total of 108 patients who had visited our institution from January 2016 to June 2018 were included in the present study. The patients were categorized as follows: degenerative adult spinal deformity with sagittal imbalance group and degenerative spinal disease group. The appendicular skeletal muscle mass index and handgrip strength of each patient were measured to evaluate for sarcopenia. Computed tomography was used to measure the cross-sectional area (CSA) and fat infiltration rate to evaluate paravertebral muscle morphology. The paravertebral muscle function was assessed by measuring the lumbar flexor strength and lumbar extensor strength using a lumbar isokinetic dynamometer. RESULTS: The degenerative adult spinal deformity with sagittal imbalance group had a lower CSA index and lumbar extensor strength index and higher fat infiltration rate than the degenerative spinal disease group. No statistically significant differences in the appendicular skeletal muscle mass index and handgrip strength were found between the 2 groups. Only the CSA showed a correlation with the radiological parameters, such as pelvic tilt and lumbar lordosis. CONCLUSIONS: Degeneration of the paravertebral muscle is a risk factor for degenerative adult spinal deformity with sagittal imbalance but not for sarcopenia. Thus, spinal sagittal imbalance is affected by isolated paravertebral muscle degeneration rather than by systemic muscle degeneration.


Subject(s)
Back Muscles/pathology , Muscular Atrophy/pathology , Neurodegenerative Diseases/pathology , Sarcopenia/complications , Adipose Tissue/pathology , Adult , Female , Hand Strength , Humans , Lordosis/diagnostic imaging , Lordosis/pathology , Lumbosacral Region , Male , Middle Aged , Muscle Strength , Muscle Strength Dynamometer , Organ Size , Risk Factors , Sarcopenia/pathology , Spine/abnormalities , Tomography, X-Ray Computed
11.
Int J Surg Pathol ; 29(3): 314-320, 2021 May.
Article in English | MEDLINE | ID: mdl-32666850

ABSTRACT

Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like lesion with unclear pathogenesis. Collision lesions of CAPNONs with neoplasms are occasionally reported. In this article, we report the first case of collision lesions between CAPNON and rheumatoid nodules (RNs) in a patient with systemic lupus erythematosus. The patient was a 51-year-old female who presented with lower back pain and subsequently a lower back mass over 2 years. Spinal magnetic resonance imaging demonstrated a heterogeneous, partially calcified mass centered in the L3-4 paravertebral regions. A biopsy of the mass was diagnostic of CAPNON. As the mass grew over the following 5 months, it was resected en bloc. Its pathological examination revealed collision lesions of RNs at different histopathological stages and CAPNON lesions, and transitional lesions exhibiting combined RN and CAPNON features, with immune cell infiltrates. Our findings provide new evidence for an immune-mediated reactive process and insights into the pathogenies of CAPNON.


Subject(s)
Calcinosis/diagnosis , Low Back Pain/immunology , Lupus Erythematosus, Systemic/complications , Rheumatoid Nodule/diagnosis , Back Muscles/pathology , Back Muscles/surgery , Biopsy , Calcinosis/immunology , Calcinosis/pathology , Calcinosis/surgery , Female , Humans , Low Back Pain/surgery , Lumbar Vertebrae , Lupus Erythematosus, Systemic/pathology , Magnetic Resonance Imaging , Middle Aged , Rheumatoid Nodule/immunology , Rheumatoid Nodule/pathology , Rheumatoid Nodule/surgery , Tomography, X-Ray Computed
12.
Exp Neurol ; 338: 113592, 2021 04.
Article in English | MEDLINE | ID: mdl-33388315

ABSTRACT

Spinal cord injury (SCI) is associated with damage to musculoskeletal tissues of the spine. Recent findings show that pain and inflammatory processes caused by musculoskeletal injury mediate plastic changes in the spinal cord. These changes could impede the adaptive plastic changes responsible for functional recovery. The underlying mechanism remains unclear, but may involve the microglia-BDNF-KCC2 pathway, which is implicated in sensitization of dorsal horn neurons in neuropathic pain and in the regulation of spinal excitability by step-training. In the present study, we examined the effects of step-training and lumbar muscle inflammation induced by complete Freund's adjuvant (CFA) on treadmill locomotion in a mouse model of complete spinal transection. The impact on locomotor recovery of each of these interventions alone or in combination were examined in addition to changes in microglia and KCC2 expression in the dorsal and ventral horns of the sublesional spinal cord. Results show that angular motion at the hip, knee and ankle joint during locomotion were decreased by CFA injection and improved by step-training. Moreover, CFA injection enhanced the expression of the microglial marker Iba1 in both ventral and dorsal horns, with or without step-training. However, this change was not associated with a modulation of KCC2 expression, suggesting that locomotor deficits induced by inflammation are independent of KCC2 expression in the sublesional spinal cord. These results indicate that musculoskeletal injury hinders locomotor recovery after SCI and that microglia is involved in this effect.


Subject(s)
Gait Disorders, Neurologic/physiopathology , Microglia/metabolism , Recovery of Function , Spinal Cord Injuries/physiopathology , Symporters/metabolism , Animals , Back Muscles/pathology , Disease Models, Animal , Freund's Adjuvant/toxicity , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/metabolism , Inflammation/chemically induced , Inflammation/pathology , Mice , Physical Conditioning, Animal , Recovery of Function/physiology , Spinal Cord Injuries/complications , Spinal Cord Injuries/metabolism , K Cl- Cotransporters
13.
Low Urin Tract Symptoms ; 12(3): 245-252, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32378362

ABSTRACT

OBJECTIVES: Urinary incontinence is a major concern after radical prostatectomy because it can decrease quality of life. The aim of the present study was to explore the effect of preoperative skeletal muscle on urinary quality of life after robot-assisted radical prostatectomy. METHODS: A total of 762 patients underwent robot-assisted radical prostatectomy. Longitudinal health-related quality of life was evaluated using the Expanded Prostate Cancer Index Composite instrument. The skeletal muscle area at the level of the third lumbar vertebra was assessed preoperatively by computed tomography and was standardized to height to obtain the skeletal muscle index. Reduced skeletal muscle size (RSMS) was defined as a skeletal muscle index ≤ 53 or ≤ 43 cm2 /m2 in patients with a body mass index (BMI) ≥25 or < 25, respectively. RESULTS: A total of 301 patients were included in this study, of whom 91 were classified as having RSMS (30.2%). Non-RSMS patients exhibited better urinary function at 12 months (P = .012) and better urinary continence recovery at 2 weeks and 12 months (P = .033 and P = .014, respectively) after prostatectomy compared with RSMS patients. Univariate and multivariate analyses identified preoperative RSMS as a significant and independent predictor of urinary incontinence (odds ratio = 1.77, P = .028). CONCLUSIONS: Patients with RSMS had a lower urinary quality of life compared with non-RSMS patients after robot-assisted radical prostatectomy, and RSMS, independent of age or BMI, was predictive of postoperative urinary incontinence.


Subject(s)
Back Muscles/pathology , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Robotic Surgical Procedures/adverse effects , Urinary Incontinence/etiology , Back Muscles/diagnostic imaging , Body Mass Index , Follow-Up Studies , Humans , Male , Postoperative Complications , Prostatic Neoplasms/complications , Quality of Life , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed
16.
Aging (Albany NY) ; 11(22): 10301-10315, 2019 11 22.
Article in English | MEDLINE | ID: mdl-31760384

ABSTRACT

BACKGROUND: In this paper, we aim to explore clinical value of skeletal muscle index (SMI) and prognostic nutrition index (PNI) on resected colorectal cancer liver metastasis (CRLM). RESULTS: Among the 539 patients, 355 were males. Baseline lower SMI was associated with smaller BMI, smaller PNI, smaller pre-albumin and longer hospitalization days (P<0.05). Patients with lower SMI and PNI had significantly shorter duration of PFS and OS (P<0.05). SMI can reflect the postoperative treatment response. Postoperative 6-month's and 12-month's SMI and PNI can indicate overall prognosis. When combined SMI and PNI, prognostic AUC of ROC curves improved significantly. CONCLUSION: Combined monitor of SMI and PNI can improve the power at predicting prognosis. Postoperative 6-month's record of SMI and PNI was more accurate and predictive for CRLM prognosis. METHOD: A total of 539 resected CRLM patients between January 2013 to December 2016 with complete clinical data were included. Computed tomography image was collected from each patient. Receiver-operating characteristic (ROC) curves were constructed; area under curves (AUC) were also determined. All clinical variables were analyzed in proper way.


Subject(s)
Back Muscles/diagnostic imaging , Liver Neoplasms/mortality , Liver Neoplasms/secondary , Lymphocyte Count , Serum Albumin/analysis , Adult , Aged , Aged, 80 and over , Back Muscles/pathology , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Female , Humans , Lumbosacral Region , Male , Middle Aged , Nutrition Assessment , Nutritional Status , Prognosis , Tomography, X-Ray Computed
17.
Respir Investig ; 57(2): 191-197, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30552073

ABSTRACT

BACKGROUND: Elderly patients who are hospitalized due to pneumonia experience deterioration of their activities of daily living (ADL) during this period; in some cases, this loss of ADL is not recovered at the end of antibiotic treatment. In this study, we examined whether erector spinae muscle cross-sectional area (ESMCSA) measured by computed tomography (CT) could predict a low level of ADL at the end of antibiotic treatment for pneumonia. METHODS: Eighty patients (mean age 74.8 years) with pneumonia, who were admitted to Yamagata university hospital between 2015 and 2016, were analyzed retrospectively. In all cases, chest CT was performed on admission and ESMCSA was measured at the level of the 12th thoracic vertebra. Patient levels of ADL were also measured, both on admission and at the end of treatment, using the Barthel Index. RESULTS: Patients with lower levels of ADL at the end of treatment were significantly older and tended to have a lower body mass index, poorer nutritional status, and more severe pneumonia than did patients who were self-reliant. Significantly smaller ESMCSAs were noted in patients who required assistance at the end of treatment than in those who were self-reliant. In multivariate logistic regression analysis, smaller ESMCSA was significantly associated with a lower level of ADL at the end of treatment, independent of age, sex, severity of pneumonia, nutritional status, or dehydration status. CONCLUSION: These results suggest that ESMCSA can predict ADL level after antibiotic treatment of pneumonia.


Subject(s)
Activities of Daily Living , Back Muscles/diagnostic imaging , Back Muscles/pathology , Pneumonia, Bacterial/pathology , Pneumonia, Bacterial/rehabilitation , Thoracic Vertebrae , Age Factors , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Body Mass Index , Female , Humans , Logistic Models , Male , Nutritional Status , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Bacterial/drug therapy , Retrospective Studies , Severity of Illness Index , Tomography, X-Ray Computed
18.
Phys Med Rehabil Clin N Am ; 29(1): 125-138, 2018 02.
Article in English | MEDLINE | ID: mdl-29173658

ABSTRACT

Prolotherapy has focused on entheses as a key source of chronic low back pain, even without clear diagnosis of enthesopathy. Treatment has traditionally been guided by anatomic knowledge and careful palpation. This article integrates ultrasonographic diagnosis of fascial injury with examination findings taught in traditional prolotherapy technique. Thoracolumbar fascial anatomy and biotensegrity theory are used to explain patient presentation and response to treatment at these pathologic findings. Detailed case reports provide proof of concept for the 60-year history of prolotherapy in the treatment of chronic low back pain.


Subject(s)
Chronic Pain/drug therapy , Low Back Pain/drug therapy , Prolotherapy , Spasm/drug therapy , Back Muscles/diagnostic imaging , Back Muscles/drug effects , Back Muscles/pathology , Back Muscles/physiopathology , Chronic Pain/diagnostic imaging , Chronic Pain/pathology , Chronic Pain/physiopathology , Female , Humans , Low Back Pain/diagnostic imaging , Low Back Pain/pathology , Low Back Pain/physiopathology , Lumbar Vertebrae , Male , Middle Aged , Prolotherapy/methods , Spasm/diagnostic imaging , Spasm/pathology , Spasm/physiopathology , Thoracic Vertebrae
19.
Biomed Res Int ; 2017: 5349620, 2017.
Article in English | MEDLINE | ID: mdl-28584816

ABSTRACT

The lumbodorsal fascia (LF) has been proposed to represent a possible source of idiopathic low back pain. In fact, histological studies have demonstrated the presence of nociceptive free nerve endings within the LF, which, furthermore, appear to exhibit morphological changes in patients with chronic low back pain. However, it is unclear how these characteristics relate to the aetiology of the pain. In vivo elicitation of back pain via experimental stimulation of the LF suggests that dorsal horn neurons react by increasing their excitability. Such sensitization of fascia-related dorsal horn neurons, in turn, could be related to microinjuries and/or inflammation in the LF. Despite available data point towards a significant role of the LF in low back pain, further studies are needed to better understand the involved neurophysiological dynamics.


Subject(s)
Back Muscles , Low Back Pain , Posterior Horn Cells/pathology , Back Muscles/innervation , Back Muscles/pathology , Back Muscles/physiopathology , Humans , Low Back Pain/etiology , Low Back Pain/pathology , Low Back Pain/physiopathology , Low Back Pain/therapy
20.
J Orthop Sports Phys Ther ; 47(3): 173-179, 2017 Mar.
Article in English | MEDLINE | ID: mdl-28158957

ABSTRACT

Study Design Cross-sectional study. Objective To determine whether there are differences in trunk muscle characteristics between older adults with and without chronic low back pain (LBP), while controlling for age, sex, and body mass index. Background Muscle support for the trunk is provided by the multifidi, erector spinae, psoas, and quadratus lumborum. Trunk muscle characteristics may be altered with aging and/or chronic LBP. To date, most trunk muscle research has been conducted among younger adults. Given age-related muscle changes, such as reduced size and increased intramuscular fat, studies are needed in older adults, including those comparing older adults with and without LBP. Methods One hundred two older adults with (n = 53) and without (n = 49) chronic LBP were included. Cross-sectional area (CSA) measurements were taken by tracing inside the fascial borders on magnetic resonance images. Pixel intensity summaries were obtained to compute muscle-to-fat indices and relative muscle CSA, that is, CSA void of fat. Right/left averages for levels L2 through L5 were determined. Mixed-design analyses of covariance were used to test for differences between groups, based on LBP presence and sex, across levels (P≤.05). Results Older adults with LBP had a greater average multifidus muscle-to-fat index (0.51 versus 0.49) and smaller average erector spinae relative muscle CSA (8.56 cm2 versus 9.26 cm2) when compared to control participants without LBP. No interactions between LBP status and average muscle characteristics were found for the psoas or quadratus lumborum (P>.05). Conclusion Up to 54% of older adult trunk muscle CSA may be fat. Women have smaller muscles and greater intramuscular fat (at lower spinal levels) than men. J Orthop Sports Phys Ther 2017;47(3):173-179. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7002.


Subject(s)
Back Muscles/pathology , Chronic Pain/physiopathology , Low Back Pain/physiopathology , Muscle Strength/physiology , Age Factors , Aged , Analysis of Variance , Back Muscles/diagnostic imaging , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Magnetic Resonance Imaging , Male
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